Accuracy of Diagnostic Mammography in Breast Cancer

Backgrounds: Diagnostic mammography is an important investigation and part of the "Triple Assessment Protocol" especially in symptomatic over 40 women with inconclusive breast pathology on clinical and ultrasonography assessment. Aim: This study aims at evaluation of the accuracy of diagnostic mammography in breast cancer. Design and Setting: An Observational Comparative Prospective Analysis conducted in the "surgical consultation clinic" and the "Breast clinic" of Al-Yarmouk Teaching Hospital; a tertiary center in Baghdad/Iraq over the period from 1st of Dec. 2013 till 31st of Dec. 2014. Patients and Methods: A cohort of 57 female patients with a mean age of 46.9 ± 10.7 years, who are complaining of breast symptoms and signs suggestive of malignancy, were included. Personal data collected and the results of clinical examination and mammography were reported and analyzed. The result of histopathological examination is considered as the "Gold Standard" against which the accuracy of mammography is evaluated. Whenever possible; statistical analysis using "Independent t-test", "Pearson's chi-square test" or "Fisher exact test" were performed and a p-value less than 0.05 was considered significant. Results: According to histopathology; two groups of patients are verified; a "Cancer" and "No Cancer" group. The mean age, smoking, positive family history and history of contraceptive pills therapy were significantly higher in the cancer group. Mass(s) is the most common pathology. Among mammography descriptions, only "well definition" of the mass attained a statistical significance supporting benign rather than malignant pathology. The only mammographic sign of malignancy which was statistically significant was presence of microcalcification(s). BIRADS grade 4 and 5 of the mammography reports proved significant in discriminating malignant from benign lesions. Statistical analysis of the results concluded a sensitivity of 78.6%, a specificity of 72.4%, a Positive Predictive Value of 73.3% and a Negative Predictive Value of 77.8%. Consequently; Diagnostic Mammography has an overall accuracy of 75.4% in this setting. Conclusions: Accuracy was lower than the reported figures for a diagnostic mammography setting. The result is partly attributed to the nature of patients sample and partly to the inconsistency of the mammography reports.